Focused ultrasound surgery has tremendous potential compared to other energy based treatment modalities. Ultrasound energy can be placed deep into tissue at precise depths with highly controlled spatial distributions. However, one difficulty has been that the sub-millimeter or millimeter sized treatment region needs to be scanned to treat, image, or monitor a large volume or to produce fractionated treatment zones composed of multiple lesions. Attempts to address such problems have been via motorized and/or electronically scanned treat mechanisms. However, such methods and systems are limited in flexibility and coverage to the scanned volume, not only of the treatment region but regions for imaging and monitoring. Further, such methods typically require the patient to be constantly moved, such as in a magnetic resonance imaging (MRI) guided ultrasound treatment system, or alternatively the mechanism to be repositioned, with limited flexibility and accuracy. For example, if a treatment mechanism treats in a line, at fixed depth, and is scanned around the circumference of an essentially circular or curved object, such as a leg, arm, fingers, foot, etc., the lesions at the fixed depth will be spaced closer or further together, or even overlap, based on the convex or concave curvature of the surface as well as treatment depth. What is needed are new, sophisticated systems and methods for ultrasound treatment which provide increased accuracy and flexibility of treatment.